Abstract: TH-PO655

Early Proteinuria Lowering by ACE Inhibition Predicts Renal Survival in Children with CKD

Session Information

  • Pediatric Nephrology
    November 02, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Developmental Biology and Inherited Kidney Diseases

  • 403 Pediatric Nephrology

Authors

  • Van den Belt, Sophie, University Medical Center Groningen, Groningen, GRONINGEN, Netherlands
  • Lambers Heerspink, Hiddo Jan, University Medical Center Groningen, Groningen, GRONINGEN, Netherlands
  • Gracchi, Valentina, University Medical Center Groningen, Groningen, GRONINGEN, Netherlands
  • de Zeeuw, Dick, University Medical Center Groningen, Groningen, GRONINGEN, Netherlands
  • Wuehl, Elke, University of Heidelberg, Heidelberg, BW, Germany
  • Schaefer, Franz S., University of Heidelberg, Heidelberg, BW, Germany
Background

Proteinuria predicts renal disease progression in adults and children with chronic kidney disease (CKD). While lowering of proteinuria by various interventional strategies has been demonstrated to be nephroprotective in adults, pediatric data are scarce. Here, we present a post-hoc analysis of the ESCAPE Trial regarding the relationship between the initial antiproteinuric effect of standardized ACE inhibition and renal disease progression in children with CKD.

Methods

All children were started on a fixed dose of ramipril (6 mg/m2/day) and subsequently randomized to aim for conventional (<95th percentile) or intensified (<50th percentile) blood pressure control. The initial log-transformed change in proteinuria was assessed from baseline to first measurement after starting ramipril (at 2.6 ± 1.4 months). Cox proportional hazard models were used to estimate the association between initial proteinuria change and risk of reaching the renal end point (composite of 50% decline in eGFR or progression to end-stage-renal disease), adjusted for age, gender, renal diagnosis, baseline proteinuria, blood pressure, eGFR and change in blood pressure.

Results

Of 285 eligible children (60% male, age 11.5±3.9 years), 81 reached the composite endpoint within 5 years of follow-up. Proteinuria was reduced following start of ramipril treatment by a median of 39% (interquartile range 7-64%). The initial proteinuria reduction was associated with a reduction in the renal composite endpoint: hazard ratio 0.71 (CI 0.41-1.23) and 0.44 (CI 0.23-0.82) for the 30-60% and >60% proteinuria reduction groups respectively compared to the <30% reduction group. This association was independent of all the above mentioned tested covariates.

Conclusion

The degree of early anti-proteinuric effect of ACE inhibition is independently predictive of long-term preservation of renal function in children with CKD. This finding lends support to the notion that proteinuria lowering should be considered an important target in the management of pediatric CKD.